I thank the correspondents for their supportive comments, examples of additional language maladies in case histories, and suggestions.

Dr. Chander's example of pejorative doctor talk in the morning report illustrates some of the misunderstanding, frustration, and anger resulting from the collision of two different cultures, one predominantly Anglo and the other Hispanic. This type of cultural conflict was recently explored by Fadiman [1].

Dr. Kane reminds us that stories are the indispensable way that human beings make sense of their everyday experience of themselves and the world. The stories of our patients tell us what sickness, disability, and medical care mean to them.

Drs. Bayoumi and Bravata justly condemn the popular practice of calling the patient a "poor historian." This poisonous misnomer also harms the speaker and the audience by obscuring the actual historian's role and the historical character of the entire history. Antidotes might include a reading of Toulmin's insightful essay about historical knowledge in medicine [2]. Furthermore, I agree that translating the patient's story of his or her experience of sickness into a history that relates the sickness solely in biomedical terms is a dismissive, authoritarian act that casts the physician as a powerful, all-knowing expert and the patient as a weak and ignorant nobody.

Although Dr. Bosch worries that physicians do not have time to transcribe the patient's perspective, he provides some examples of progress notes that convey the patient's voice both briefly and adequately. However, his labeling of the patient's perspective as "soft history" would perpetuate the mischief engendered by calling the patient's account "subjective."

Dr. Delanty rightly faults the careless use of "status post CABG" to describe the patient. Correctly punctuated, the words "status: post" modify instead the disorder for which surgery was performed: coronary arteriosclerotic heart disease; status: post coronary-aorta bypass graft.

Dr. Wu suggests adding the letter "E" for education to HOAP [history, observations, assessment, and plans]. However, the P in HOAP stands for, as it did in SOAP, plans for 1) diagnosis, 2) treatment, and 3) patient education.

Dr. Sigal's observations remind us that problem-oriented formulas such as SOAP and HOAP are necessarily reductive, best at dealing with such matters as a symptom, an abnormal physical finding, or a disease. To convey patients' views of their personal situation, it is often better, as I suggested in my article, to write a progress note captioned simply as "history" or, better yet, as "patient perspective."